perphenazine and amitriptyline hydrochloride (Etrafon - brand no longer available in the US) (cont.)

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Anxiety or agitation with depression: Initial dose is one tablet of 2/25 mg
or 4/25 mg by mouth three to four times a day OR take one tablet of 4/50 mg by
mouth twice a day.

Depression with
schizophrenia: Initial dose is two tablets of 4/25 mg by
mouth twice or three times a day, a fourth dose may be given at bedtime.

Maintenance dose for all patients: Take one tablet of 2/25 mg or 4/25 mg by
mouth two to four times a day OR take one tablet of 4/50 mg by mouth twice a
day. 2/10 mg and 4/10 mg doses can be used to increase flexibility in adjusting
maintenance dosage to the lowest amount consistent with relief of symptoms.

The maximum dose is 16/200 mg per day.

DRUG INTERACTIONS: Perphenazine/amitriptyline should be used with caution
with medications like paroxetine (Paxil), fluoxetine (Prozac), and sertraline
(Zoloft) because these medications also increase the concentration of
neurotransmitters in the body leading to severe and deadly reactions.

Perphenazine/amitriptyline should be avoided with medications like quinidine,
disopyramide (Norpace), procainamide (Pronestyl), propafenone (Rhythmol), and
flecainide (Tambocor) because they may also affect heart rhythm and increase the
risk of an irregular heart rate and rhythm.

Perphenazine/amitriptyline should be used with caution with medications like
epinephrine due to increased risk of irregular heart rates and rhythms.

PREGNANCY: Newborn babies may be at risk for withdrawal or extrapyramidal
symptoms. Perphenazine/amitriptyline is not recommended for use in
pregnant
women.

NURSING MOTHERS: Perphenazine/amitriptyline enters breast milk and is not
recommended during
breastfeeding.

SIDE EFFECTS: Side effects of Perphenazine/amitriptyline are abnormal muscle
contractions, difficulty breathing and swallowing, neck spasms, and movement
abnormalities on face, arms, and legs. This medication also causes dizziness,
drowsiness, sedation, irregular heart rate and rhythm, increase or decrease in
blood pressure, and blurred vision.